Simulation model for planning renal services in a district health authority.

OBJECTIVE--To investigate the use of a computer simulation model in planning and budgeting for renal replacement services. SETTING--Regional renal unit. RESULTS--The simulation provided projections that accurately reflected the actual numbers of people maintained on different forms of renal replacement therapy in previous years. Projections up to the end of the century showed that with no change in the demand for the service the total number of people on the renal replacement programme would increase by 40%. Increasing the uptake of new patients from 40 per million to 55 per million would mean an increase of 66% in patient numbers over the same period. Similarly, at present day prices the cost of providing the service would rise by 31% with no change in demand and by twice this with the greater uptake of new patients. Increasing the number of transplant operations was shown to offer little prospect of a reduction in these costs. CONCLUSION--The simulation program could be used by individual renal units to evaluate different treatment policies and to budget for resource use. Even at current demand levels resource requirements for renal replacement therapy will continue to grow until after the end of the century.     

Implications of land cover change on ecosystems services and people’s dependency: A case study from the Koshi Tappu Wildlife Reserve,Nepal

Protected areas, a corestone of biodiversity conservation, provide a vast array of ecosystem services to support livelihoods of people. However, protected areas, especially freshwater, are under threat with overexploitation of resources changing the land covers and degrading their capacity to supply services. Information on land cover changes and its implications on ecosystems, its services and people, especially in developing countries at a local scale, is largely absent. This study, therefore, seeks to understand people's dependency on ecosystem services and implications of land cover change on ecosystem services and people, with a case study in the Koshi Tappu Wildlife Reserve of Nepal. Using both qualitative and quantitative methods, our findings show high dependency of the locals on a vast array of ecosystem services provided by the reserve. More than half of the sampled households were found to directly derive income from ecosystem services of the reserve. However, land cover changes especially declines in forest (16%), swamps/marshes (4%), rivers (14%) and other ecosystems over a period of 34-years impacted the provision of ecosystem services and people’s dependency notably. The services from forests declined by about 94%, swamps services by 36% and services from river by 57% which were reported to be the high service suppliers. People's dependency, as perceived by the locals, was reduced by 67% over the last ten years. The study highlighting the supply, demand and implications on ecosystem services and people helped to better understand the complex interaction between humans and ecosystems. These results can be used to develop holistic approaches to restore, conserve and manage the ecosystems, and its services by balancing equal supply and demand of ecosystem services required for a self-sustaining human-environment system. It can also contribute to development of important environmental policies and programs in the area.     

Teaching and training in geriatric medicine in the European Union

In 1993 about 20% of the population in the 15 'old' member countries of the European Union (EU) was over 60 years of age and this percentage will increase to more than 25% in 2020. These developments play a key role for the investments in education and training to meet societies needs for health care services. In 2002 about 25% of the medical students in the 'old' EU did not receive any education in geriatric medicine. A question is who will provide the services for older people in related areas, like social care, community care, acute care in the hospitals, long-term care, permanent care and care for psychiatric patients? Geriatric medicine has been recognized as an independent specialty in 8 of the 15 member countries of the 'old' EU. In all EU member states the governments are autonomous regarding all aspects of health care services, including the recognition of specialties and specialist training programmes. A two years training in internal medicine has been recommended in the EU, followed by another four years of training in geriatric medicine. The specialist training has a hospital oriented character, however, it includes also community care and other institutionalised care like nursing homes. The curriculum should contain: biological, social, psychological and medical aspects of common diseases and disturbances in older people. A problem in many EU countries is the shortage of well trained researchers and leading persons for academic positions for geriatric medicine. In a number of countries chairs at the universities remain vacant for long periods of time or even disappear. Good services in the health care for older people need a high quality curriculum and training programme.     

Shrink and share: humanity's present and future Ecological Footprint

Sustainability is the possibility of all people living rewarding lives within the means of nature. Despite ample recognition of the importance of achieving sustainable development, exemplified by the Rio Declaration of 1992 and the United Nations Millennium Development Goals, the global economy fails to meet the most fundamental minimum condition for sustainability--that human demand for ecosystem goods and services remains within the biosphere's total capacity. In 2002, humanity operated in a state of overshoot, demanding over 20% more biological capacity than the Earth's ecosystems could regenerate in that year. Using the Ecological Footprint as an accounting tool, we propose and discuss three possible global scenarios for the future of human demand and ecosystem supply. Bringing humanity out of overshoot and onto a potentially sustainable path will require managing the consumption of food, fibre and energy, and maintaining or increasing the productivity of natural and agricultural ecosystems.     

Demand incidence and episode rates of ophthalmic disease in a defined urban population.

OBJECTIVES--To estimate demand incidence and episode rates of ophthalmic disease in a defined urban population over one year. DESIGN--Study of patients presenting with eye problems to general practice and eye casualty department. SETTING--General practice and ophthalmic services in west Nottingham. SUBJECTS--36,018 people from the combined practice lists of 17 Nottingham general practitioners. MAIN OUTCOME MEASURES--Ophthalmic disorder, age and sex of patient, and where presented. RESULTS--587 consultations were recorded for ophthalmic problems, 1771 with general practitioners and 816 with eye casualty. Most consultations to general practice were by females (1066 (60%)), whereas men aged 15-44 accounted for most work in eye casualty. These men commonly presented with trauma. Infective conjunctivitis, the commonest condition, had an episode rate of 13.5/1000 population/year. Demand incidence for cataracts was 1.9/1000 population/year. Demand incidence for chronic conditions increased with age. CONCLUSIONS--As the average age of the population increases demand for ophthalmic services will rise. Planning and provision of resources to meet this increased demand should be considered now.     

Denmark: the elderly living in style.

In the next 20 years every country in Western Europe will see a rise in its total numbers of people aged over 60, and since old people are now living longer the proportion aged over 75 will also rise. Both physical and mental disorders become much more common between 60 and 75, so that if these old people are to be provided with accommodation and medical services at contemporary standards many more places will be needed in sheltered flats, nursing homes, and geriatric hospitals. Yet in the current economic recession most European countries are trying to cut back on public expenditure. How do politicians and administrators reconcile the conflict between the demands created by demographic change and the freeze on public spending? How will the care of the elderly change in response to this conflict? Tony Smith is examining the ways in which old people are looked after in several European countries and their plans for the future. This first article deals with Denmark.     

Analysis of services available for total joint replacement surgery.

The use of a total joint replacement surgery has been growing in a manner which is poorly understood. This growth is more likely to be limited by saturation of the available medical services than by a limit to the number of people who could benefit from the treatment. Present indications are that services will be saturated in 1974 or 1975, after which 4600 extra people a year will go on to the waiting lists if demand continues as at present. Stability can then be achieved by either raising the clinical criteria for surgical treatment or making about 300 extra orthopaedic beds available each year, buffered from the demands of acute trauma admissions.     

New roles for general practitioners.

General practice is likely to change greatly over the next few years. Increases in care in the community and day surgery will lead to more work, and the demand for better data on practice activity will mean the development of audit and epidemiological work. To make time general practitioners will have to learn to delegate work that does not require a doctor. Fundholding has already stimulated some practices to bring services to patients rather than send patients to hospital, and this trend seems set to continue. It is important to pool resources, not only within practices but among other practices in the area--joint action will increase the ability to improve the services for patients. If general practitioners take the opportunity to gain control of the changes the morale of the profession should improve.     

Estimated burden of diabetes mellitus in Manitoba according to health insurance claims: a pilot study.

OBJECTIVE: To estimate the burden of diabetes mellitus in Manitoba from 1980 to 1984. DESIGN: Review of the Manitoba Health Services Commission (MHSC) database. The validity of the MHSC data was established through two substudies: one involved self-reports from a survey of elderly Manitobans, and the other involved people with confirmed diabetes enrolled in the provincial diabetes education program. SUBJECTS: Sample of 100,000 people stratified by age, sex and MHSC health region: 50,000 were aged 25 to 64 years, and 50,000 were aged 65 or more. All MHSC claims containing the ICD-9-CM code for diabetes mellitus or gestational diabetes were identified. MAIN RESULTS: Of the sample 7627 people were found to have a diagnosis of diabetes, the annual prevalence being 0.8% among those 25 to 44 years of age, 3.5% among those 45 to 64 and 7.6% among those 65 or older. The annual incidence rate among those over 25 years of age was 7.8 per 1000. Of the 4556 pregnant women 25 to 44 years old 85 (1.9%) had diabetes; 23 were believed to have gestational diabetes. CONCLUSIONS: The incidence and prevalence rates were similar to those determined on the basis of self-reports in Canadian and US national surveys. The use of an administrative database such as that of the MHSC will provide key information for planning health services for diabetic patients and will permit the monitoring of long-term trends in the incidence and prevalence of the disease.     

Health and social status of elderly Asians: a community survey.

A sample based on general practices was the starting point for a community survey of Asians aged 65 years and over to describe: family structure and social contact; aspects of lifestyle; language and communication; capacity for self care; and knowledge about and use of services. A total of 726 (95% of those approached) old people were interviewed in their own languages. Almost all had been born in India, mainly in Gujarat or the Punjab, but most had come to Britain via east Africa. Over half of the over 75s were not fully independent in basic activities of daily living, and a fifth were occasionally or often incontinent of urine, though these levels of incapacity were little different from those found in the indigenous elderly. Few elderly Asians were aware of social services, such as meals on wheels, home helps, social workers, and particularly chiropody. Language also excluded them: 37% of men and only 2% of women could speak English. Moreover, two thirds of elderly Asian women were illiterate in all languages. Health education initiatives directed at these people must understand these cultural and language barriers and perhaps use alternative methods, such as Asian radio programmes and home videos, in providing information on health and welfare services.     

基于土地利用与土地覆被的长三角生态系统服务供需空间格局及热点区变化

快速城市化与土地利用变化导致区域生态系统服务供需失衡,进而使得生态环境恶化已成为共识。开展生态系统服务供需关系及其空间量化研究,有助于识别出区域中存在的主要生态环境问题及其关键驱动。以长江三角洲为研究区,基于土地利用与土地覆被和生态系统服务供给和需求评价矩阵的方法对1985—2015年长三角生态系统服务供需盈亏格局及热点变化进行分析,结果表明:1)长三角地区生态系统服务供给减少,需求增多,生态系统服务盈余区从1985年的40.9%下降至2015年的38.5%,生态系统服务赤字区面积占比从1985年的1.3%增长到2015年的10.6%,总体呈现供不应求的趋势; 2)沪宁杭城市发展梯度带上生态系统服务供需盈亏呈"V"型分布,且30年内城市中心及其附近的生态系统服务供需值下降更为明显; 3) 30年内长三角生态系统服务供需盈余热点区整体变化不大,30年内面积减少了0.1%;而赤字热点区则呈现出快速扩张趋势,面积占比30年内增加了14.9%。说明随着城市化进程的加快,长三角生态系统服务供需亏损状况更严重; 4)生态系统服务供需评价矩阵可以比较简便、全面的反映出生态系统服务供需盈亏状况,研究结果可对快速城市化地区生态环境与土地利用规划与管理提供有益参考。     

The impact of projected increases in urbanization on ecosystem services

Alteration in land use is likely to be a major driver of changes in the distribution of ecosystem services before 2050. In Europe, urbanization will probably be the main cause of land-use change. This increase in urbanization will result in spatial shifts in both supplies of ecosystem services and the beneficiaries of those services; the net outcome of such shifts remains to be determined. Here, we model changes in urban land cover in Britain based on large (16%) projected increases in the human population by 2031, and the consequences for three different services--flood mitigation, agricultural production and carbon storage. We show that under a scenario of densification of urban areas, the combined effect of increasing population and loss of permeable surfaces is likely to result in 1.7 million people living within 1 km of rivers with at least 10 per cent increases in projected peak flows, but that increasing suburban 'sprawl' will have little effect on flood mitigation services. Conversely, losses of stored carbon and agricultural production are over three times as high under the sprawl as under the 'densification' urban growth scenarios. Our results illustrate the challenges of meeting, but also of predicting, future demands and patterns of ecosystem services in the face of increasing urbanization.     

京津冀地区城市化对典型生态系统服务供需关系的影响

京津冀地区是中国经济最发达、人口最密集的地区之一,快速的城市化进程严重影响了生态系统服务的供需关系。为了使京津冀地区在未来的城市化进程中实现社会经济发展与生态环境保护中的可持续协调发展,需要正确理解城市化对生态系统服务供需的影响,为京津冀地区生态环境管理提供参考依据。因此,基于Pearson相关性、随机森林、双变量局部空间自相关等方法探究京津冀地区不同城市化强度区域内生态系统服务供需的匹配关系以及对城市化对生态系统服务供需的影响特征。研究发现：2000-2020年间,京津冀地区城市化综合水平涨幅达到148.15%;碳储存和生境质量服务赤字区域扩增明显,食物生产与PM_2.5去除服务盈余区域有所增加,但各项生态系统服务供需空间错配性较强;城市化对生态系统服务供需比具有显著的负相关关系;既有城市化区域生态系统服务对空间城市化和人口城市化敏感性较强,城市化扩张区域和农村区域对空间城市化敏感性较强,空间城市化是影响生态系统服务供需关系的主要因素;不同城市化水平区域内城市化与生态系统服务供需比的错配特征具有显著差异。因此,本文探究了不同城市化强度区域内城市化指标对生态系统服务供需影响的差异性,为实现京津冀地区的城市化与生态系统服务的协同发展提供科学依据。     

基于文献计量的自然资本研究现状及热点

文章以Web of Science数据库中检索的自然资本相关文献为数据源,利用文献计量方法,分析相关文献按年份的数量变化特征、世界各国中主要研究力量和高产作者发文情况,探究目前的研究现状。之后利用Bibexcel得出高频关键词共词矩阵,导入Ucinet和NetDraw得出共现网络可视图,最后对关键词进行聚类分析。研究表明,①自然资本相关文献数量整体呈上升趋势,可大体分为萌芽发展、加速发展和成熟发展3个增长阶段;②从研究力量上看,发达国家的影响力明显强于发展中国家,美国处于遥遥领先的地位,中国起步晚,影响力较小,国际合作需要加强;③根据共词分析得出生态系统服务的价值化和可持续发展是当前的研究热点;④利用聚类分析将高频关键词分成了生态脆弱性与适应性、资本经济与自然资源、生态系统服务和资本经济管理四类。分析结果表明,未来自然资本的研究将集中于生态系统服务的价值化研究、InVEST模型的应用、绿色经济发展与区域绿色经济转型、小尺度区域服务功能价值评估及自然资本的动态评估等方面。     

Forest ecosystem assessment,changes in biodiversity and climate change in a densely populated region (Flanders,Belgium)

Abstract

Throughout the world, forest covers one-third of the land's area. Present and historical human activities caused tremendous land use changes and triggered the onset of unseen climate changes. Yet, these socio-economically based environmental changes interfere with services that forests provide to mankind from global to local scales. Densely populated regions such as Flanders (Belgium), with over 430 people per km², have the dubious honour to serve as examples of extreme human induced forest changes. The issue of forest biodiversity is reviewed in the light of the Millennium Ecosystem Assessment scheme. Flanders is a poorly forested region (11% forest cover); supporting services are consequently low. Merely 16% of that area has known 230 years of continuous forest cover, representing forest with the highest current biodiversity. Also, the demands for regulating services are growing and the limits may have been reached. Provisioning services may increase again in future when demands for, for example bio-energy, increase. Cultural services, particularly the recreational function, have increased greatly. Human well-being in Flanders partly depends on the services provided by forest ecosystems. However, as demands on forests are huge, a shift to a sustainable use of forest resources will be essential to assure its beneficial role for present and future generations.     

Prevalencia de los trastornos de ansiedad en las personas mayores de 65 años: una revisión sistemática

Anxiety is an emotional problem that causes discomfort and suffering to those that suffer from it. Anxiety disorders can affect the functioning in different facets of a person's life. Studies on the prevalence of anxiety disorders in people over 65 years show variable results, ranging between 0.1% and 17.2%. Most of these studies include samples of the general population, in which the population of people over 65 years is under-represented. These studies evaluate older people with the same diagnostic tools used to assess anxiety disorders in people under 65 years, and collect data from people between 65 and 75 years old, leaving out people aged 75 and over. A systematic review of the prevalence studies of anxiety disorders in elderly people is presented. It is concluded that when representative samples of people over 65 years are used and evaluated with suitable tools, the prevalence rate of these disorders in the elderly is much higher than previously thought, reaching an annual prevalence rate of 20.8%.     

生态系统服务功能的空间尺度特征

生态系统服务功能的形成依赖于一定的空间和时间尺度上的生态系统结构与过程,只有在特定的时空尺度上才能表现其显著的主导作用和效果。不同尺度的生态系统服务功能对不同行政尺度上的利益相关方具有不同的重要性。一般而言,生态系统产品提供功能往往与当地居民的利益更密切;调节功能和支持功能通常与区域、全国,甚至全球尺度的人类利益相关;文化功能则与本地-全球尺度上的利益相关方关系密切。由于不同尺度的生态系统服务功能有时互相冲突,从而可能导致不同的生态系统管理策略。本文探讨了生态系统服务功能在不同空间尺度上的表现特征和生态系统服务功能的空间规律,论述了不同空间尺度上生态系统服务功能与不同行政尺度上利益相关方的关系,以期为生态系统服务功能的评价、生态补偿机制的建立与生态系统管理提供科学依据。     

Temporal trends in cardiovascular demand in EMS: Weekday versus weekend differences

Diagnosed cardiovascular disease has well-reported temporal patterns, with demand distribution peaks in the late morning and greater case numbers on Mondays and in winter. We aimed to report temporal patterns of presumptive cardiovascular disease cases as determined after emergency medical services (EMS) assessment and to characterize the demand distribution by day of the week. We conducted a secondary analysis of all Ambulance Victoria cases in metropolitan Melbourne (Victoria, Australia) between January 2008 and December 2011. Analyzed data included time of call, incident mechanism, location type, final assessment (paramedic “diagnosis”) and patient age. We employed Poisson’s regression to analyze case numbers and trigonometric regression to quantify distribution patterns. The 182?983 cases of presumptive cardiovascular disease observed during the study period constituted 15.2% of total demand. The median age of persons attended was 72 (IQR 57–82) and there was an almost even split between genders (51% female). Peak numbers of most cardiovascular case types occurred between 09:00 and 11:00; the only exception was acute pulmonary edema, which had peak case numbers at 06:00. Trigonometric regression showed distinct time of day distribution patterns, which did not alter by season. Although weekend day demand was lower than on Mondays, due to a different distribution pattern, these differences were not constant over the 24-hour period. There were up to 27% fewer cases at 09:00 and up to 2.8% more cases at 01:00 on weekends compared to Mondays. We have shown that examination of presumptive cardiovascular disease using not only case counts but also demand distribution patterns allows for a greater understanding of ambulance demand. Monday might be the most frequent day for cardiovascular cases but different patterns of demand occur on weekends. Increased knowledge of when different types of cases are most likely to occur will help inform EMS planning, including paramedic capacity and resources.     

京津冀地区生态系统服务供需测度及时空演变

生态系统服务供需状况深刻影响地区生态安全与经济社会的可持续发展。以京津冀为研究区,选取产水、碳固持以及粮食生产3项生态系统服务,应用InVEST模型、ArcGIS空间分析模块,定量测度2005年与2015年京津冀地区生态系统服务供需水平,探索京津冀地区生态系统服务供需时空格局及类型演变特征。结果表明：（1）在2005年与2015年,京津冀地区产水服务处于供需赤字状态,碳固持服务和粮食生产服务处于供需盈余状态,且各项生态系统服务供需状态呈显著的空间异质性;（2）2005年与2015年京津冀地区生态系统服务综合供需状况呈赤字状态,主要赤字范围以京津为中心呈环状分布,并在此期间范围有所扩大。（3）基于生态系统服务供需状况,将京津冀各县区划分为生态涵养区、生态保育区、生态改良区、生态恢复区以及生态控制区,并针对各类型区生态系统供需状况及其时空演变规律,提出了相应的政策建议。     

Capacity,pressure, demand,and flow: A conceptual framework for analyzing ecosystem service provision and delivery

Ecosystem services provide an instinctive way to understand the trade-offs associated with natural resource management. However, despite their apparent usefulness, several hurdles have prevented ecosystem services from becoming deeply embedded in environmental decision-making. Ecosystem service studies vary widely in focal services, geographic extent, and in methods for defining and measuring services. Dissent among scientists on basic terminology and approaches to evaluating ecosystem services create difficulties for those trying to incorporate ecosystem services into decision-making. To facilitate clearer comparison among recent studies, we provide a synthesis of common terminology and explain a rationale and framework for distinguishing among the components of ecosystem service delivery, including: an ecosystem's capacity to produce services; ecological pressures that interfere with an ecosystem's ability to provide the service; societal demand for the service; and flow of the service to people. We discuss how interpretation and measurement of these four components can differ among provisioning, regulating, and cultural services. Our flexible framework treats service capacity, ecological pressure, demand, and flow as separate but interactive entities to improve our ability to evaluate the sustainability of service provision and to help guide management decisions. We consider ecosystem service provision to be sustainable when demand is met without decreasing capacity for future provision of that service or causing undesirable declines in other services. When ecosystem service demand exceeds ecosystem capacity to provide services, society can choose to enhance natural capacity, decrease demand and/or ecological pressure, or invest in a technological substitute. Because regulating services are frequently overlooked in environmental assessments, we provide a more detailed examination of regulating services and propose a novel method for quantifying the flow of regulating services based on estimates of ecological work. We anticipate that our synthesis and framework will reduce inconsistency and facilitate coherence across analyses of ecosystem services, thereby increasing their utility in environmental decision-making.